Provider Demographics
NPI:1740848530
Name:JEFFERSON HEALTH NEW JERSEY DIRECT PRIMARY CARE, P.C.
Entity type:Organization
Organization Name:JEFFERSON HEALTH NEW JERSEY DIRECT PRIMARY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RUNFOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-883-5249
Mailing Address - Street 1:308 N HADDON AVE STE 308-1
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1723
Mailing Address - Country:US
Mailing Address - Phone:856-883-5249
Mailing Address - Fax:856-477-2539
Practice Address - Street 1:308 N HADDON AVE STE 308-1
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1723
Practice Address - Country:US
Practice Address - Phone:856-883-5249
Practice Address - Fax:856-477-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty